While big-money insurance corporations amass premiums and fees to add to their already excessive "reserves" and administrative costs, the lack of access to affordable health care is a serious problem for rural Minnesotans -- whether they are farmers, small business owners, students or workers. Many farmers depend on a spouse with an off-farm job for coverage, and beginning farmers say health insurance is one of the biggest impediments to getting started.

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We need a health care system in Minnesota in which everyone is in and no one is left out. Effective, efficient models for this kind of universal care are already in place in other countries and are widely popular. In Canada, for example, a recent national poll found 86 percent supported keeping their health care system public.

Now Minnesota has the opportunity to make health care more accessible and affordable. Under the Affordable Care Act passed by Congress in 2010, states are empowered to provide their citizens access to a health benefit exchange, through which individuals and small businesses can look into health coverage options and compare health plans. One big benefit -- the exchanges can help millions of low and middle-income families buy down their premium with public dollars, based upon their income.

Minnesota has wisely chosen to set up its own exchange, which means we can establish our exchange to meet the unique needs of our state. While the exchange is an opportunity to make health coverage more affordable and accessible, there's a big risk that the health insurance industry will dominate the process and force an exchange that's little more than an online corporate marketing plan for their over-priced insurance.

Governor Mark Dayton is now set to start making decisions about the structure of our exchange. Minnesotans have an important choice to make. Will we let our exchange be governed by the insurance industry, which will maintain the status quo of a confusing, expensive and inequitable system that prioritizes their profits over our health? Or will we create a democratically governed exchange that can negotiate prices with insurance firms, address geographic and racial inequities in health care, and make decisions that prioritize the interests of the people of Minnesota?

Minnesota has a long history of citizen engagement in our democracy. We have the power to shape our health care system, starting with taking control of our health care exchange. If we ever doubt our power to effect meaningful reform, we need only to look to our neighbors up north. The reform movement that ultimately won universal access to care in Canada got its beginnings in farm country--Saskatchewan Province.

In the first decades of the 20th Century, most rural Canadians had little access to medical care. Sparsely populated "rural municipalities" took it upon themselves to address the problem, voting to retain doctors through the use of taxpayer funds. Over the course of the following decades, rural municipalities stayed at the forefront of modern health care improvements in North America: passing legislation for municipal hospitals, authorizing publicly-funded treatment for tuberculosis and creating health districts, which allowed rural residents more options in their health care.

Very much a grassroots movement, Saskatchewan's progress in health care was the result of rural people taking local action to address health care needs in their communities, and the provincial government responding by authorizing and extending the reforms. In 1946, under the leadership of Premier Tommy Douglas, Saskatchewan became the first province to provide universal coverage of hospitalization and preventative care. A Baptist minister turned organizer and politician, Douglas preached the social gospel and dedicated his life to the fight for universal health care for all Canadians.

Other provinces adopted reforms similar to those of Saskatchewan and in 1962 the Canadian federal government passed universal health care legislation. In the years since, Canadians consistently give their public health care system high marks, and in 2004 Tommy Douglas was voted the "Greatest Canadian" of all time by the people of Canada.

We too have the power to change our broken health care system. An important first step is to organize to use the health benefits exchange to improve health care options for Minnesotans now.

The key is this: the people of Minnesota need to run the decision-making process for our new health care exchange, not the insurance industry. An exchange that belongs to us will move us toward a health care system that works for rural and urban people alike.

Paul Sobocinski is a crop and livestock farmer in Redwood County and an organizer with the Land Stewardship Project.